Which statement best describes the appropriate steps to take after discovering fraud?

Which statement best describes the appropriate steps to take after discovering fraud?

• A. Seek knowledgeable legal counsel only.
• B. Determine what money was collected in error from patients and report and return overpayments only.
• C. Seek knowledgeable legal counsel; determine what money was collected in error from patients and from the federal health care programs and report and return overpayments; unwind the problematic investment; disengage from the suspicious relationship; Consider using OIG's or CMS's self-disclosure protocols.
• D. Do nothing.

Answer: (C)

When fraud is discovered, the response should be comprehensive and proactive, combining legal guidance with a thorough assessment of the scope and immediate remediation. The best approach is to bring in knowledgeable legal counsel to navigate the process, then determine precisely what money was collected in error from patients as well as from federal health care programs, such as Medicare or Medicaid. Any overpayments must be reported and returned to the appropriate party, and internal records should be corrected to reflect the accurate transactions. It’s also important to unwind any problematic investments and disengage from suspicious relationships to halt ongoing improper activity. Finally, consider using established self-disclosure protocols from the OIG or CMS to collaborate with authorities in a structured way, which can help mitigate potential penalties and demonstrate cooperation. A narrower response—seeking only legal counsel, or addressing only patient overpayments, or doing nothing—misses key steps needed to properly remediate and limit liability, while the full, proactive sequence in the best option covers both the financial corrections and the relationship/disciplinary actions plus potential self-disclosure.

When fraud is discovered, the response should be comprehensive and proactive, combining legal guidance with a thorough assessment of the scope and immediate remediation. The best approach is to bring in knowledgeable legal counsel to navigate the process, then determine precisely what money was collected in error from patients as well as from federal health care programs, such as Medicare or Medicaid. Any overpayments must be reported and returned to the appropriate party, and internal records should be corrected to reflect the accurate transactions. It’s also important to unwind any problematic investments and disengage from suspicious relationships to halt ongoing improper activity. Finally, consider using established self-disclosure protocols from the OIG or CMS to collaborate with authorities in a structured way, which can help mitigate potential penalties and demonstrate cooperation.

A narrower response—seeking only legal counsel, or addressing only patient overpayments, or doing nothing—misses key steps needed to properly remediate and limit liability, while the full, proactive sequence in the best option covers both the financial corrections and the relationship/disciplinary actions plus potential self-disclosure.